Alcohol Detox Protocol: Safe Withdrawal in Any Setting

Alcohol withdrawal occurs when you stop or reduce drinking after a long period of use. Withdrawal symptoms can range from mild to severe and can be medically significant or even life-threatening. Detox programs and alcohol detox protocol are recommended for those in early recovery from alcohol use disorder.¹

What Are the Goals of Alcohol Detox Protocol?

According to the American Society of Addiction Medicine, the three most immediate goals of any alcohol detox protocol are to:¹

1. Provide a safe detox from alcohol and help the patient become alcohol-free
2. Provide a humane detox experience that honor’s the patient and protects their dignity
3. Prepare the patient for ongoing substance abuse treatment

Medically assisted detox programs help stabilize people going through alcohol withdrawal.. You receive medical support to prevent serious symptoms, such as withdrawal seizures and delirium tremens (DT), a condition characterized by hallucinations, tremors, anxiety, and delirium. DT is a rare withdrawal effect—it affects only 1-5% of people—but it can cause permanent damage or be life-threatening without medical care.²

Medically assisted detox also helps lay the foundation for long-term recovery. Your detox treatment team prepares you for ongoing psychosocial addiction treatment, such as inpatient addiction treatment, counseling, and peer support. You also receive a plan for any long-term medical maintenance you may need.³

What Does Outpatient Alcohol Detox Protocol Look Like?

Outpatient alcohol detox protocol can be just as effective as inpatient detox. Research indicates that completing an outpatient detox programs is associated with more participation in long-term follow-up treatment than detoxing in an inpatient setting.⁴

Who Enters Outpatient Detox?

Outpatient detox is safe and effective for people experiencing mild withdrawal symptoms who have no history of neurological symptoms or previous serious withdrawal complications.

Outpatient programs can be more affordable since you live at home while receiving treatment and can allow you to continue to work or attend school during treatment if you are medically able.

What Happens in Outpatient Detox?

If you are admitted to an outpatient treatment program, you will be monitored and assessed daily. Your treatment team may prescribe you a withdrawal medication regimen, instruct you on how to take it properly, and discuss possible medication side effects.

Typically, withdrawal medications are administered daily at each outpatient visit to help promote medication safety and prevent people from misusing the medication. Some medications have other methods of administration as well, such as extended release injection. Your treatment team may also prescribe you daily vitamins such as thiamine, folic acid, and a multivitamin to help support your body during detox.⁴

Many outpatient detox programs include access to individual, family, and group counseling as well as 12-step programs and other peer support groups. Beginning psychosocial treatment programs during the withdrawal period can help set you up for a successful recovery. You will identify your triggers for use, develop healthy coping skills, and be referred to professional support to help you address any underlying traumas or co-occurring mental health disorders that may contribute to your alcohol use.¹

What Does Inpatient Alcohol Detox Protocol Look Like?

For more severe cases of alcohol withdrawal, inpatient alcohol detox is recommended. Inpatient treatment is more appropriate for those with moderate to severe withdrawal symptoms.⁴

As many as 10% of people detoxing from alcohol require inpatient treatment.² Some indications that inpatient treatment may be needed are:¹

• Recent high levels of alcohol consumption
• Pregnancy
• History of severe withdrawal symptoms
• History of delirium tremens (DT)
• Co-occurring mental health or physical condition
• Multiple previous detoxifications
• Lack of a reliable social support network

Ideally, all patients who experience seizures during the detox process should be monitored for at least 36-48 hours afterward to ensure no further seizures occur. Monitoring may take place in an inpatient facility or sometimes in a hospital.⁵

An inpatient alcohol detox protocol may include: ⁴

• Intravenous fluids
• Intravenous medications
• Extensive monitoring of blood pressure, heart rate, body temperature, and blood levels of various chemicals in the body

In extreme cases, sedation may be used for part of the detox process.

What Does Alcohol Detox Protocol at Home Look Like?

In some cases, it may be best for people to detox from alcohol at home, while still under the supervision of a medical professional. Telehealth detox protocols have become more prevalent in the last two years as humanity is facing a global pandemic. Therefore, it may sometimes be safer for people to remain at home during the detox process.²

Virtual alcohol detox programs are not suited for those with a history of severe withdrawal symptoms such as seizures and delirium tremens. Telehealth detox programs typically require that patients join an outpatient treatment program once detox is complete.²

What Alcohol Detox Medication Protocol Is Used in Treatment?

Every year around 500,000 cases of alcohol withdrawal are severe enough to require medication management.⁶ Many medications may be used to treat alcohol withdrawal symptoms.

Historically, benzodiazepines have been used most frequently to reduce physical agitation and prevent symptoms from progressing.^2,5,6 However, benzodiazepines have a high potential for misuse, are not effective in patients with DT, and can interfere with behavioral treatments.²

There are only three FDA-approved medications for treating alcohol addiction:

• Disulfiram
• Acamprosate
• Naltrexone

Other medications may be used off-label during detox to improve alcohol withdrawal symptoms. These additional medications include: ^1,2,5,6

• Anticonvulsants such as gabapentin
• Promethazine
• Trazodone
• Ibuprofen
• Hydroxyzine
• Certain antipsychotics
• Beta-blockers

Medications may be given on a fixed dosage schedule or as a symptom-triggered regimen, where symptoms have to reach a certain level of severity before the next dose is given.

Individuals with co-occurring mental health disorders or medical conditions are monitored more closely and may require unique medication regimens that suit their specific health needs.

How Is Your Alcohol Detox Treatment Plan Developed?

Treatment plans flexibly help your care team identify and address your needs during alcohol detox.

Intake

During the intake process, your treatment provider performs a physical exam to check for ailments such as fever, dehydration, abnormal heart rate, abnormal blood pressure or breathing, and shakiness. Your doctor will likely conduct blood work and may administer other diagnostic tests.⁴

Assessment

You may also be given an assessment to determine your risk of severe alcohol withdrawal symptoms. Some questions you may be asked include:²

• When did you last drink alcohol?
• How often do you drink alcohol?
• How much do you drink on each occasion?
• How long have you been drinking at this frequency?
• Are you currently taking any other medications, recreational substances, or illicit drugs?
• Do you currently have any medical conditions?
• Do you have any of the following symptoms: seizures, confusion, sweats, or hallucinations?
• Are you currently pregnant or could possibly be pregnant?

You may also be given a Prediction of Alcohol Withdrawal Severity Scale (PAWSS) screening as well. This screening asks a series of questions and provides each patient with a score to predict how severe their withdrawal symptoms may be and helps determine which level of care is most appropriate.²

Service Planning

Once you complete your initial intake and screening, your provider creates a treatment plan tailored to your unique needs. Treatment typically involves medication, psychosocial support, and nutritional counseling. Intravenous fluids are odten given for cases of dehydration. Those with more severe withdrawal symptoms may require intravenous medications as well.

Discharge and Aftercare

You be discharged from treatment when you have completed the detox process and are free from most withdrawal symptoms. Some people may have lingering alcohol withdrawal symptoms that can last for months. These include:⁴

• Sleep changes
• Mood swings
• Fatigue

These symptoms can persist due to changes that long-term alcohol use cause in brain structure and neurochemical function.

Keep up with aftercare programs after discharge in order to help you maintain long-term sobriety and prevent relapse. Your treatment team will likely refer you to an inpatient rehab or outpatient program.

Other aftercare programs your treatment team may recommend include individual counseling, family therapy, group counseling, 12-step programs, and medication maintenance.

If you or a loved one are in recovery from alcohol use disorder and would like information about starting an alcohol detox protocol, call 800-996-6135(Who Answers?) to get help today.

Resources

1. Bayard, M., Mcintyre, J., et al. (2004). Alcohol Withdrawal Syndrome. American Family Physician. 69(6), 1443-1450.
2. Colodner, G. & Douaihy, A. Practical Review of Alcohol Withdrawal Management During the Coronavirus Pandemic.
3. Newman, R., Gallagher, M., & Gomez, A. (2021). Alcohol Withdrawal. StatPearls Publishing.
4. S. National Library of Medicine. (January 2021). Alcohol Withdrawal. MedlinePlus.
5. Kattimani, S. & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: a systematic review. Industrial Psychiatry Journal, 22(2), 100-108.
6. Hoffman, R. & Weinhouse, G. (2021). Management of moderate and severe alcohol withdrawal syndromes.